When Does a Bridge Become a Barrier?

Transcription

1 1 VHA Mission When Does a Bridge Become a Barrier? Patty Greim, MS RN-BC Diane Bedecarre, MS RN-BC Donna DuLong, BSN Summer Institute of Nursing Informatics (SINI) 2009 Baltimore, MD The mission of the Veterans Health Administration is to serve the needs of America's veterans by providing primary care, specialized care, and related medical and social support services. About VHA Web page: 2 Objectives Vision Identify a vision for patient data Describe the current state of patient data Share our experience on the journey toward reing consistent models of meaning st Century Health Care Back in the 20 th Century DATA Res conditions, treatments, and outcomes Helps patients and providers see and address care concerns Drives care, process improvement, research, evidence-based practice, and guidelines 5 Patient s current status identified Patient s desired status identified Gap between current and desired states guides interventions Expert systems help to move patients from current status to desired status Adapted from Dr. Cimino s slides in Cimino, J. J., Teich, J. M., Patel, V. L., Zhang, J. (1999) What is wrong with EMR? Retrieved 6/13/2008 from What%20is%20Wrong%20with%20EMR.ppt 6

2 7 Current state Gap in standards 8 Business Problem The Goal VA application development Patient Assessment Template Clinical Flow Sheet (CLIO) Commercial Off the Shelf Applications (COTS) Clinical Information Systems (CIS) Anesthesia Record Keeper (ARK) 9 If we store data using consistent reations, regardless of the source of the data, we can efficiently and effectively retrieve and reuse information. Huff, S. M., Rocha, R. A., Coyle, J. F., Narus, S. P. (2004). Integrating detailed models into application development tools. Medinfo 2004, IMIA. Retrieved 7/23/2008 from 10 Standardization Workgroup Informatics Project Goals Terms for Clinical Observations (CliO) Database Terms for Nursing Patient Assessment Terms for CIS/ARK Goal: Nationally Standardized Terminology for use in Clinical Documentation Terms from each project reconciled to each other and Mapped to SNOMED CT to be used as the core terminology catalog for Clinical Documentation Systems Develop a process for integrating terms from other disciplines and ongoing maintenance and adding new terms 11 Develop a repeatable process to reation of data Identify common observations of interest Re observations with reference terminologies Describe the knowledge about the observations using mind maps Re knowledge as comparable, implementable models 12

3 13 Terminology Spreadsheets Methods NURSING ASSESSMENT Pulses - Peripheral: POSTERIOR TIBIAL PULSE - RIGHT CliO Pulses - Peripheral: Pulses - Peripheral: RADIAL - RIGHT Pulses - Peripheral: RADIAL - LEFT Pulses - Peripheral: DORSALIS PEDIS PULSE - RIGHT Pulses - Peripheral: DORSALIS PEDIS PULSE - LEFT Cardiovascular Observations Proposed ENTERPRISE TERM Pulses - Peripheral: Peripheral Pulse Radial Pulse Radial Pulse - Duplicate from above Dorsalis Pulse Dorsalis Pulse - Duplicate from above Posterior Tibial Pulse Brachial Pulse LOINC Arterial pulse intensity: Type: Pt: XXX: Nom: Palpation Arterial pulse intensity: Force: Pt: Radial artery.right: Arterial pulse intensity: Force: Pt: Radial artery.left: Arterial pulse intensity: Force: Pt: Dorsal pedal artery: Arterial pulse intensity: Force: Pt: Dorsal pedal artery.left: Arterial pulse intensity: Force: Pt: Posterior tibial artery.right: Arterial pulse intensity: Force: Pt: Brachial artery.left: SNOMED CT SNOMED CT SNOMED PREFERRED SYNONYMS CT CODE TERM Peripheral pulse, Peripheral pulse function Peripheral pulse Radial pulse Right Dorsalis pulse Left Dorsalis pulse 1.Dorsalis pedis pulse 1.Dorsalis pedis pulse Posterior tibial pulse Left Brachial pulse SNOMED CT HIERARCHY observable entity qualifier value qualifier value qualifer Literature review Engaging with experts Developing and comparing models of meaning Engaging with partners: Standards Development Organizations Brachial Pulse Absent Arterial pulse intensity: Force: Pt: Brachial artery.right: Right Brachial Pulse Absent Femoral Pulse Arterial pulse intensity: Force: Pt: Femoral artery.left: Left Femoral pulse Mind Maps UML Concept Models The Journey to date Collaborative Partners at VA Process Steps Phase 1 Phase 2 Phase 3 Phase 4 Terms collected and harmonized from two applications (Standardization effort) Standardized Terms mapped to reference terminologies (SNOMED CT, Clinical LOINC) Concept reation and modeling with clinicians (detailed models) Exploring ways to formalize model reations initial set of terms identified and harmonized Terminology matched to Initial set Adding terms from CIS/ARK Validating terminology matches Developing Mind Maps Adding terminology matches to CIS/ARK Validating Mind Maps Developing UML diagrams 17 Office of Nursing Services Patient Care Services Clinical Information Systems & Anesthesia Recovery Knowledge (CIS/ARK) Projects Office of Health Information Chief Health Informatics Office Standards and Interoperability: Terminology Standards Office of Information & Technology Standards and Terminology Services (STS) VHA Health Information Model (VHIM) Team Project Teams (Clinical Observations, etc.) v5 18

4 Slide 18 v5 Is the VHIM team part of OI&T? vhacocodurc, 7/20/2009

5 19 End Game The right data at the right time for the right decisions to promote the health, dignity and well-being of Veterans and their families Acknowledgements Bonny Collins Dr. Siew Lam Dave Alvey Janet Morris Holly Miller Luigi Sison John Carter Tim Cromwell Linda Fischetti 20 Computable, Interoperable, Reusable Questions? References 1 of 4 References 2 of 4 Bouhaddou, O., Lincoln, M.J., Maulden, S., Murphy, H., Warnekar, P., Nguyen, V., Lam, S., Brown, S. H., Frankson, F., Crandall, G., Hughes, C., Sigley, R., Insley, M., Graham, G. (2006). A Simple Strategy for Implementing Standard Reference Terminologies in a Distributed Healthcare Delivery System with Minimal Impact to Existing Applications. AMIA Annu Symp Proc. 2006; 2006: Retrieved 7/23/2008 from Cimino, James J. (1998) Desiderata for controlled medical vocabularies in the twenty-first century. Methods of Information in Medicine. Cimino, J. J., Teich, J. M., Patel, V. L., Zhang, J. (1999) What is wrong with EMR? Retrieved 6/13/2008 from What%20is%20Wrong%20with%20EMR.ppt Clark, J., & Lang, N. (1992). Nursing's next advance: An internal classification for nursing practice. International Nursing Review, 39(4), , 128. Dykes, P. C., Kim, H., Godsmith, D. M., Choi, J., Esumi, K., Goldberg, H., The adequacy of ICNP Version 1.0 as a Reational Model for Electronic Nursing Assessment Documentation. Journal of the American Medical Informatics Association. 16; Goosen, W.T.F.,(2008). Using detailed models to bridge the gap between clinicians and HIT. In: De Clercq E. et.al. (Eds). Collaborative Patient Centered ehealth. Proceedings of the Healthcare Amsterdam. IOS press, Harris, M., Graves, J. R., Solbrig, H.R., Elkin, P.L., Chute, C.G.(2000). Embedded structures and nursing knowledge reation. Journal of the American Medical Informatics Association. Vol. 7 No. 6. November/December Hendrix, S.E. (er), Dumas (er), R., & Panettieri, J. (Moderator). (2002). Standard procedures: Implementing a standardized nursing language within an EMR. (webinar). Eclipsys. Retrieved January 20, 2009, from Huff, S., Practical modeling issues: Reing coded and structured patient date in EHR systems. Power point ed May 20, Huff, S. M., Rocha, R. A., Coyle, J. F., Narus, S. P. (2004). Integrating detailed models into application development tools. Medinfo 2004, IMIA. Retrieved 7/23/2008 from 24

6 25 References 3 of 4 References 4 of 4 Kim, H., Harris, M., Savova, G.,Chute, C., (2008). The first step toward data reuse: Disambiguating concept reation of the locally developed ICU flowsheet. CIN Computers Informatics Nursing. 26;5, Kleinsorge,, R., Willis, J., Emrick,, S. (2007). AMIA 2007 Tutorial T12 Unified Medical Language System UMLS Overview National Library of Medicine, National Institutes of Health, U.S. Dept. of Health & Human Services. Retrieved 7/23/2008 from pt Lundberg, C., Brokel, J., Bulechek, G., Butcher, H., Martin, K., Moorhead, S., Peterson, C., Spisla, C., Warren, J. & Giarrizzo-Wilson, S. (June, 2008). Selecting a Standardized Terminology for the Electronic Health Record that Reveals the Impact of Nursing on Patient Care. Online Journal of Nursing Informatics (OJNI), 12, (2). Available at Nursing Terminology Summit (2002). Development, evaluation and use of reference terminology for nursing: Progress report from the Nursing Terminology Summit. Retrieved 6/13/2008 from Ozbolt, J. (2008). Nursing terminology standards: A Brief Overview. University of Maryland ation shared by personal correspondance Rosenbloom, S. T., Miller, R. A., Johnson, K.B., Elkin, P. L., Brown, S. H. (2006). Interface terminologies: facilitating direct entry of data into Electronic Health Record Systems. Journal of the American Medical Informatics Association, Vol. 13, No. 3, May/June. Retrieved 6/13/2006 from Stead, W. W., Lin, H. S., eds Computational Technology for Effective Health Care: Immediate Steps and Strategic Directions Committee on Engaging the Computer Science Research Community in Health Care Informatics; National Research Council. Retrieved February 9 at 26